Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225400000X | Rehabilitation Practitioner |
NPI | 1003461203 |
---|---|
Provider Name | Jasmine Martinez |
First Address | Pasadena, CA 91101-1403 |
Second Address | Los Angeles, CA 90007-3033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2019 |
Last Update Date | 21/12/2021 |